Guarantee

Point of Service Plan

Hybrid of HMO & PPO w/ greater flexibility on choosing specialists outside network w/ benefits still provided but @ higher co-pay.

which of the following bets describes presumptive disability?

one that is severe enough that the insured automatically qualifies for full disability benefits

Carlos's health insurance policy pays benefits according to a list which indicates the amount that is payable under each type of covered treatment or procedure. Carlos's policy provides benefits on a

scheduled basis

Notice of claim written notice has to be submitted to insurer in

20 days

a person received his medicare supplement policy and is not satisfied. how long does he have to return it after first look?

30 days

when an agent changes address of their resident or office, the insurance department must be notified within

30 days

An insured undergoes a minor surgical procedure. the insured owes the insured 500 in medical claims. however the last premium of 200 due was never paid. how much should the insured get in claims?

300

the Omnibus budget reconciliation act of 1990 requires that large group health plans (100 employees or more) must provide primary coverage for nonretired disabled people under the age of

65

Omnibus Budget Reconciliation Act (OBRA)

Federal law that regulates the education and testing of nursing assistants

which statement best described agreement as it relates to insurance contracts?

one party accepts the exact terms of the other party's offer

which of the following is Not a common exclusion found in most health policies

Dental procedure due to a birth defect

managed care plan

a type of health-care plan in which the insurance company contracts with specific doctors, hospitals, and other health-care providers to deliver medical services and preventive care to members at reduced cost

an underwriter is reviewing an applicant with an extensive medical history. which of the following would give the underwriter a better understanding of how the applicant has been treated

attending physicians statement

regarding health insurance, all of the following are tax0deductible EXCEPT

employee paid group disability income

regarding health insurance, all of the following are tax deducible except

employer paid group long term care

which of the following is NOT correct concerning taxation of a disability income benefit?

if paid by the individual , the premiums are tax deductible

coordination of benefits provision

in group health insurance is designed to prevent overinsurance and the duplication of benefits if one person is covered under more than one group health insurance plan

with a conditionally renewable policy, the premiums are more likely to be

increased

an insured's hospital states that it will pay him a flat fee of 75 per a day for each day he is hospitalized. the policy pays benefits on what basis?

indemnity

Insured's have the right to do which of the following if they have not received the proper claim forms within 15 days of their notice to the insurer of a coverage loss a major medical policy

submit the description in their own words on a plains sheet of paper

AD&D

Accidental Death and Dismemberment insurance. A limited form of Health insurance that covers accident only. It is the only type of Health insurance that covers death. AD&D policies do not follow the Principle of Indemnity, in that they pay in addition to any other coverage the insured has.

conditional receipt

In Life and Health insurance, a Conditional Receipt provides that if premium accompanies the application, coverage shall be in force from the date of application (whether the policy has yet been issued or not) provided the insurance company would have issued the coverage on the basis of facts as revealed by the application and other usual sources of underwriting information. Remember, there is never any coverage unless the premium has been paid!

an insurer can decide not to renew an optionally renewable policy

On premium due dates

When may HIV-related test results be provided to the MIB?

Only if the individual is not identified

A core Medicare supplement policy (Plan A) will cover all of the following expenses EXCEPT a) Part A deductible b) The first 3 pints of blood c) 20% if Part B coinsurance amounts for Medicare-approved services d) Part A coinsurance

Part A deductible

which of the following is NOT true regarding term health coverage

The owner may renew the policy for a specified term.

probationary period

The period of time between the effective date of a health insurance policy and the date coverage for all or certain conditions begins.

Time of payment of claims provision

monthly

on an accidental death and dismemberment (AD&D) policy, the death benefit payable is known as the

principle sum

an insured has a heart attack while jogging, but is expected to return to work in 6 weeks. the insured's disability income policy will

replace a % of his lost income

HMOs are known as what type of plan

service

a man is an attorney when he applies for a health policy. he decides to become a professional bungee jumper. he files a claim. what should happen

the insurance company will pay the claim according to the benefits available if the correct premium had been paid

an insured is anxious to get treatment for a health condition, and is convinced that a specialist is needed to cure the condition. if the insured has a PPC plan which of the following is true

the insured can select any specialist but non network specialists will have a higher out of pocket cost

Medicare is a health insurance program for all the following except

those with low income and low assets

if an application submits the initial premium with an application, which action constitutes acceptance?

underwriter approves the contract